MYELOPATHY Flashcards
Types of MYELOPATHY
🧠⚡ CMD⚡
- Compressive Myelopathy
✨ Extra medullary
➡️ Intradural
➡️ Extradural
✨ Intra Medullary - Non-compressive Myelopathy
⚡⚡ MOST COMMON MYELOPATHY
Extramedullary Extradural
Extramedullary Extradural causes
- Vertebral #
- Disc herniation
- TB of Vertebra
- Syphilis of Vertebra
- Extradural abscess
- Metastasis in Vertebra
- Aneurysm
Extramedullary Intra-dural compressive MYELOPATHY
🧠⚡MeN have Extra ID ⚡
Meningioma
Neurofibroma
Intramedullary Compressive
Causes
🧠💡SOME💡
Ependymoma
Syringomyelia
Medulloblastoma
Oligodendroglioma
Compressive MYELOPATHY feature
@ Same Level
@ Below the level
⭐ LMN Motor loss, Reflexes lost, Hyperaesthesia
⭐ Complete MOTOR and SENSORY LOSS.(UMN type)
Pain in EXTRAMEDULLARY EXTRADURAL POSTEROLATERAL(Disc Herniation)
⭐ POSTEROLATERAL : RADICLE PAIN( Brief, SHOCK like Lancinating Pain)
⬇️
Lower LIMB Weakness
⬇️
Posterior Column Involvement
(Numbness and Tingling)
Pain in EXTRAMEDULLARY EXTRADURAL POSTERIOR Disc Herniation
Depends on:
- Posterior Column Involvement ➡️ BAND LIKE SENSATION ➕ LHERMITTE’S Sign ➕ UPPER LIMB WEAKNESS (GLOVE AND STOCKING Pattern)
- LATERAL COLUMN: DULL ACHING PAIN, FUNICULAR PAIN
INTRAMEDULLARY CORD COMPRESSION
SYRINGOMYELIA
- Bowel and Bladder Involvement
- Spinothalamic tract involved
- Sparing of DCML ➡️ DISSOCIATIVE SENSORY LOSS
- Pain and Temperature sensation lost: TROPHIC ULCER, CHARCOT JOINTS
- Anterior Horn cell Involvement LMN WEAKNESS
Difference BETWEEN INTRAMEDULLARY vs EXTRAMEDULLARY Cord Compression
🧠💡Intramedullary: BeST DL💡
🧠💡Extramedullary: RP² Singh💡
3Ps of CORD COMPRESSION
- Pain ➕
- Proteins in CSF ⬆️
- Pyramidal signs: EARLY
Proteins in CSF is ⬆️ ⬆️ when
ROOT Involvement is ➕
Epiconus vs Conus Medullaris vs CAUDA Equina
CAUDA is Asymmetric
L5 functions
Extensor Hallucis Longus
Hip Abduction
UMN type lesions are seen in CAUDA EQUINA vs CONUS MEDULLARIS?
🧠⚡ Conus - Cone of spinal cord - UMN signs ⚡
🧠⚡Cauda equina is the lower part of the spinal cord - LMN signs⚡
Conus Medullaris
If the conus medullaris is damaged, UMN type of lesion will occur - with hyperreflexia.
Cauda equina are nerves that exit the spinal cord.If the cauda equina is damaged, LMN type of lesion will occur - with hyporeflexia or areflexia
Perianal anesthesia is seen in CAUDA EQUINA vs CONUS MEDULLARIS?
🧠⚡ Conus rhymes with anus for perianal anesthesia ⚡
Conus Medullaris
✨ Saddle Loss
✨ Anal & Bulbocavernosus reflex LOST
SYMMETRY is seen in CAUDA EQUINA vs CONUS MEDULLARIS?
🧠⚡ cAudA has A’s for Asymmetric involvement ⚡
Cauda equina syndrome is usually asymmetric.
Conus medullaris is symmetric.
Bowel Bladder, Sexual Activity Involvement SEEN in CAUDA EQUINA vs CONUS MEDULLARIS?
Conus gives an early Bonus (Bowel and Bladder)
Conus medullaris has early onset of bowel and bladder involvement.
CES has late onset bladder involvement.
U/L or B/L seen in CAUDA EQUINA vs CONUS MEDULLARIS?
🧠⚡ Conus Bilateral Bonus! ⚡
Conus MEDULLARIS has B/L Symmetrical and SUDDEN onset
LOWER BACK PAIN seen in CAUDA EQUINA vs CONUS MEDULLARIS?
🧠⚡meduLLaris has two L’s for low back pain. ⚡
✨ Conus medullaris has low back pain. Radicular pain is absent.
✨ CES back pain is less severe. Radicular pain is present in CES.
🧠⚡Conus involves a conical structure ⚡
Conus medullaris frequently causes impotence.
In CES, impotence is absent.
Direct Tendon Reflexes LOST seen in CAUDA EQUINA vs CONUS MEDULLARIS?
Bulbocavernosus reflex lost in both
Cauda Equina:
Loss of ANKLE and KNEE Reflex
Conus MEDULLARIS: Hyperreflexia
Knee reflex normal, ankle reflex lost
MOTOR WEAKNESS seen in
CAUDA EQUINA
Weakness and Wasting in Thigh and Leg muscle
Conus MEDULLARIS Sensory Distribution
Saddle Distribution
ACUTE SPINAL CORD ISSUE RULES OUT WHAT TYPE OF MYELOPATHY
⭐ ⭐ ⭐ COMPRESSIVE MYELOPATHY IS RULED OUT
MOST PROBABLE Dx : NON COMPRESSIVE MYELOPATHY
MOST ACUTELY PRESENTING NON COMPRESSIVE MYELOPATHY
Acute TRANSVERSE MYELITIS
Cause
✨ IDIOPATHIC
✨ POST INFECTIOUS
✨ POST VACCINATION
Anterior Spinal Artery Infarction is seen in which age group
OLD AGE
Approach to SPINAL CORD Involvement
Spinal cord involvement
💡🪔 POINTER🪔: B/L INVOLVEMENT
⬇️
SENSORY SYMPTOMS
1. ROOT PAIN / BAND LIKE PAIN ➡️ COMPRESSIVE MYELOPATHY
- ACUTE SPINAL FEATURES ➡️ TRANSVERSE MYELITIS
Causes of NON COMPRESSIVE MYELOPATHY
🧠⚡VITAMIN ⚡
✨ VASCULAR : Anterior Spinal Artery infarct, Spinal arteriovenous malformation (AVM)
✨ INFLAMMATORY: TRANSVERSE MYELITIS, MULTIPLE SCLEROSIS
✨ TOXINS : ARSENIC
✨ AUTOIMMUNE: Sarcoidosis > > SLE
✨ METABOLIC : VITAMIN B12 DEFICIENCY
✨ INFECTION: Syphilis, TB, HIV, HTLV1
✨ NEOPLASM
✨ DEGENERATIVE : MOTOR NEURON DISEASE
SYRINGOMYELIA
TRANSVERSE MYELITIS
💡🪔CLINICAL POINTER🪔
ACUTE CORD FEATURES
➕
B/L NUMBNESS, TINGLING SENSATION
➕
B/L COMPLETE MOTOR LOSS
➕
PAIN, SUDDEN, SEVERE ✨ BAND LIKE ✨ AT LEVEL OF SEGMENT
➕
Combination of SENSORY, MOTOR AND BLADDER SYMPTOMS
Monophasic INFLAMMATORY Demyelinating Disease affecting Multiple segments of Spinal Cord
Transverse Myelitis
Clinical DIAGNOSIS of TRANSVERSE MYELITIS
⭐ MRI : HYPER INTENSITY/ ENHANCING LESIONS
⭐ CSF Pleocytosis
⭐ INCREASED IgG INDEX
💊💉 MANAGEMENT of TRANSVERSE MYELITIS
- STEROIDS: Mainstay TREATMENT
methylprednisolone 500mg-1gm - PLEX
Indications of PLASMA EXCHANGE IN TRANSVERSE MYELITIS
- Inability to WALK
- Marked Impaired AUTONOMIC FUNCTION
- Sensory Loss in the LOWER EXTREMITIES
- No clinical improvement after 5-7 days of IV STEROIDS
3 Conditions with
B/L ABSENCE OF KNEE JERK and ANKLE JERK
➕
EXTENSOR PLANTAR (BABINSKI REFLEX)
🧠⚡FAST ⚡
- Friedrich’s ATAXIA
- Subacute DEGENERATION of Spinal Cord (Vitamin B12 deficiency)
- Tabes Dorsalis
- Cerebellum NORMAL ➕ ATAXIA
- Cerebellum ATROPHY ➕ ATAXIA
- FRIEDRICH’S ATAXIA
- ATAXIA TELENGIECTASIA
Commonest form of SPINOCEREBELLAR DEGENERATION
Friedrich’s Ataxia
Why both UMN and LMN lesions in FRIEDRICH’S ATAXIA?
Spinal Cord ➕ Ganglion Disease
1st STRUCTURE AFFECTED IN FRIEDRICH’S ATAXIA
LAST STRUCTURE AFFECTED IN FRIEDRICH’S ATAXIA
⭐ DORSAL ROOT GANGLION (LMN features)
⬇️
SPINOCEREBELLAR Tract DEGENERATION
⬇️
Posterior COLUMN: DCML
⬇️
CORTICOSPINAL TRACT (MOTOR)
⬇️
⭐ PERIPHERAL NERVES
FRIEDRICH’S ATAXIA
🧠⚡IE ⚡
F: Frequent falls, ataxia
R: Recessive
IE:
D:Dorsal column affected - Loss of vibratory and proprioceptive sensation occurs
R: Recessive
I:
C: Cerebellar involement - Nystagmus, fast saccadic eye movements, truncal ataxia, dysarthria, dysmetria
Choreioform movements
H: Hypertrophic cardiomyopathy
High plantar arch, High steppage gait
S: Scoliosis
Trinucleotide Repeat in FRIEDRICH’S ATAXIA
🧠⚡ATAXIA h toh GAA kar dikha ⚡
Gene involved
Chromosome
GAA
⭐ Frataxin Gene
⭐ Ch 9
Non neurological features of FRIEDRICH’S ATAXIA
- Pes cavum
- Optic Atrophy *
- KyphoScoliosis
- Myocardial FIBROSIS
- Cardiomyopathy
- Diabetes Mellitus
- Hammer Toe
Tracts involved in SCDSC
Posterior column
⬇️
Corticospinal tract
⬇️
Lateral Spino-Thalamic Tract
SCDSC
POSTEROLATERAL cord syndrome (UMN)
➕
NERVE ISSUES (REFLEX LOST)
Conditions ASSOCIATED with SCDSC
- B/L OPTIC NEUROPATHY
- MENTAL CHANGES
Dorsal ROOT Ganglion Involvement
➕
Bladder Involvement
➕
PAIN
➕
SENSORY ATAXIA
➕
Pupil Changes
Tabes Dorsalis
Bladder: OVERFLOW INCONTINENCE
Pupil: ARP
Difference between FRIEDRICH’S ATAXIA vs TABES DORSALIS vs SCDSC
ONION PEEL FACE seen in
SYRINGOBULBIA
DUE TO: Involvement of Spinal nucleus of TRIGEMINAL Nerve
Syringomyelia
💡🪔CLINICAL POINTER🪔
♂️ > ♀️
- YOUNG ♂️
-ASSOCIATED with ARNOLD CHIARI Malformation
-DISSOCIATIVE sensory loss
- WASTING of THENAR eminence, Forearm, Arm
HALF CAPE DISTRIBUTION seen in
SYRINGOMYELIA
